Drug prohibition, said Ruth Dreifuss, former president of Switzerland and chair of the Global Commission, “is a problem that is touching all aspects of life and society—not just oppression, not just public health.” However, “It is very important to focus on the fact that the main obstacle to public health is the criminalization on users.”

Accordingly, the Commission’s latest report calls unequivocally for the total abolition of all penalties—criminal, and also civil—for possession for personal use. Detailing the damage done to human rights and public health by prohibition, it highlights the contrasting successes of decriminalization models, when accompanied by suitable social and harm reduction services.

The Commission ultimately favors not only total decriminalization but also forms of legal regulation for all drugs—bringing additional benefits, like protecting consumers from dangerously adulterated products, and ending the persecution of people who sell drugs.

Here are the five key recommendations from the report:

So how realistic are these aims? The messages from a world where 33 countries still execute people for nonviolent drug-law violations yet others have decriminalized extensively are decidedly mixed—as are those from an America that simultaneously elects Donald Trump and legalizes marijuana in several states. Back in April, the Global Commission slammed the failure of the UNGASS 2016 drug policy summit to produce meaningful change.

Ruth Dreifuss spoke to me yesterday of how people “refusing to see the reality, chasing the illusion, thinking [drug use] is just an issue of weakness of the people … can gain more influence in a society who elected people like Donald Trump: [the idea of] just have an ordered society to be ‘clean’ in all senses of the word—clean from foreigners, from all kinds of people who do not conform to their standards.”

But she also noted that hardship itself can be a grim source of hope. “It’s a pity politicians react in an emergency situation only,” she said, comparing the European AIDS crisis of the ’80s and ’90s with the current US crisis of opioid-related deaths—one that she believes will force US politicians to seek alternative responses.

[The commissioners at yesterday’s press conference, from left to right: César Gaviria, former president of Colombia; Pavel Bém, former mayor of Prague and Czech “drug czar;” Ruth Dreifuss, former president of Switzerland; Michel Kazatchkine, former executive director of the Global Fund; Paul Volcker, former chairman of the US Federal Reserve.]

“It’s been the strong view of the Commission from the very beginning [it formed six years ago] that prohibition and law enforcement have failed,” said Michel Kazatchkine, former executive director of the Global Fund to fight AIDS, tuberculosis and malaria. “More drugs are available, cheaper new drugs every week come on the market, and more drugs are used. Prohibition has created a huge illegal market of several hundred billion dollars that threatens stability and fuels corruption and violence. Criminalization is leading every day in every part of the world to human rights abuses: state-sanctioned murders in Philippines; the death penalty … detention centers in Asia.”

The public health impact has also been severe. Of the world’s injecting drug users, he reminded us, “One in five are infected with HIV; two out of three with hepatitis.” Criminal laws, forcing drug users into unsafe practices and impeding the implementation of harm reduction measures that save lives, are largely responsible.

In the US, Kazatchkine continued, “criminalization has led to a wave of over-incarceration.” He noted that of 1.5 million drug-related arrests in the US in 2015, 83 percent were for simple possession, and that a criminal record is a huge impediment to employment and other life prospects. “And everywhere, ethnic minorities and people economically vulnerable in society are disproportionately arrested.”

On the other hand, he pointed out, “there is absolutely no evidence that decriminalization increases consumption.” By way of illustration, he compared higher cannabis consumption rates in France, where it is strictly prohibited, with lower ones in the Netherlands, where it is extensively decriminalized.

“The consensus around prohibition being the approach is broken,” he declared. “We have to move to regulation, but we have to start pragmatically.” He concluded: “A state should only interfere with an individual’s private life if there is good reason. Millions of people across the wold use drugs without causing any harm to others. Criminalization is disproportionate and undermines the right to privacy and the right to dignity and personal autonomy.”

The commissioners confirmed that their new report’s emphasis on decriminalization, more than legal regulation, was a pragmatic decision, based on what is initially more politically achievable and publicly palatable.

Ruth Dreifuss knows a thing or two about winning the public over to drug policies that initially appear radical. During spells as Swiss president, vice president and minister of home affairs between 1993 and 2002, she oversaw the implementation of measures including syringe access, supervised drug consumption rooms and large-scale trials of legally prescribed heroin for long-term users (HAT). In 2008, once such policies had greatly reduced deaths and crime, 68 percent of Swiss voters approved a referendum measure that included HAT as a permanent part of the country’s drug policies.

Similarly, Swiss communities that had first viewed supervised drug consumption rooms with suspicion came around. “The progress was so visible that the neighborhoods accepted them,” Dreifuss told me. “Most of the places I know have been there for years and years; they belong. The spread of safe consumption rooms shows that the public is ready to accept something that sounds quite bad or paradoxical, that is quite difficult at the beginning to explain.”

Her fellow commissioner Pavel Bém, former mayor of Prague and former Czech “drug czar,” also has an illustrious record of helping to implement enlightened policies. Drug possession for personal use was entirely decriminalized in his country during the 1990s, and he and his allies sought to maximize that opportunity.

“We introduced HIV testing programs, outreach programs for the hidden population, ORT programs … and within a few years, the outcomes were astonishing,” he said. “The Czech Republic currently has one of the lowest HIV rates among injecting drug users, one of lowest mortality rates … and one of the lowest rates of drug-related crime.”

In 1999, Czech politicians introduced a bill that partially rolled back the successful decriminalization policy—and unwittingly provided a perfect case study. “We were able to push government to continue monitoring the new punitive law,” he said. “In a three-years study, the outcome was again astonishing—there was zero positive effect; there were severe negative public health and criminal justice impacts. So we decided to remove the new law.”

Bém also cited the example of Portugal, which decriminalized all drugs in 2001: “In 15 years, incidents of new HIV cases dropped 91 percent—that’s phenomenal. There were 80 percent savings in social costs—partly by people not losing jobs by getting sent to jail.”

“The economic impact of decriminalization is enormous,” he concluded, “but … even more important is health. Looking at the scientific evidence, there is zero argument for keeping punitive drug policies.” But he cautioned, “Decriminalization by itself is not enough; it has to be accompanied by social and public health and harm reduction measures.”

Her fellow commissioner César Gaviria, former president of Colombia, condemned the waste of resources prohibition entails: “We don’t want police in bars trying to find a small amount of marijuana—that is a stupid and un-useful policy.”

Noting that Latin America is arguably the region of the world most affected by drug policies, he spoke of the futility of persecuting people who grow coca. “You will never know a [farmer who gets rich]—they probably only earn 80 percent of minimum wage, so to call them a criminal makes no sense.” Of the US, he said: “This country seems to go conservative, but the plebiscites on [marijuana] were all approved—why? Because people recognize that [prohibition] doesn’t work.”

Gaviria also made an interesting tactical point, asserting that because “libertarian views are not the majority” when it comes to drugs, it is, from an advocacy viewpoint, “better if you move with the point that all drugs are ‘bad’—now, how can we work with them in a way that is less bad for society?”

The strategy of not disputing that “drugs are bad” in order to advance harm reduction and decriminalization is a controversial one. I asked Ruth Dreifuss whether it was not also important to emphasize that although the harms of drugs are real—if greatly exacerbated by bad policies—they are also routinely exaggerated: Many would be surprised to learn that the UN Office on Drugs and Crime, hardly a radical body, estimates that only just over 10 percent of all drug use is problematic.

“Both are true,” she replied, explaining that it’s important to be honest about the relative dangers, while accepting that it might be hard for some people to believe. “It is true that there is reasonable, controlled consumption, and most use is not problematic.” She pointed out that with most illicit drug use, when people get a little older, “when they have a family, have a job, generally they stop.”

“Alcohol is a good example,” she continued. “There is a whole culture of reasonable consumption of wine—and there is also the culture of binge drinking of young people, which is dangerous.”

Her fellow commissioner Paul Volcker, former chairman of the US Federal Reserve and the Economic Recovery Board, also used the example of alcohol to illustrate how a better alternative to prohibition needn’t mean having no rules. “We don’t prohibit alcohol; we find various means of some regulation. We don’t sell it to children; we tax it.”

And asked whether recent marijuana legalization in US states might inspire other parts of the world, he flipped it around, illustrating how great examples of successful drug policy already exist, but aren’t necessarily known about here.

“I see it more as the United States catching up a little with what’s going on in some other parts of the world.”

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The purpose of The Global Commission on Drug Policy is to bring to the international level an informed, science-based discussion about humane and effective ways to reduce the harm caused by drugs and drug control policies to people and societies.

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